Risk Factors for Chronic Pain after Open Ventral Hernia Repair by Underlay Mesh Placement

Incisional hernia is a frequent complication following abdominal surgery. Repairs that include the use of mesh have been associated with decreased recurrence. The aim of the present study was to determine the outcomes and risk factors for chronic pain after ventral hernia repair with underlay placement of a composite polypropylene mesh. A retrospective study was conducted from September 2005 to June 2008. The study included consecutive patients who underwent elective incisional hernia repair with underlay composite mesh placement. Postoperative course, recurrence, pain, and patient satisfaction were assessed by an independent observer. Chronic pain was defined as significant pain persisting after 3 months as assessed using a 10-point numeric scale (a parts per thousand yen3: chronic pain, a parts per thousand yen7: severe pain). After a mean follow-up period of 24.6 months, 109 of 121 patients operated on during the period were evaluated. No patients experienced small bowel obstructions, enterocutaneous fistulas, or mesh infections leading to the need for mesh removal. The recurrence rate was 6.1 % at the repair site and 10.5% at another site. Thirty-one patients (28%) had chronic pain and seven patients (6.6%) had severe pain. Affective and nociceptive components were the majority of complaints. Chronic cough was the only variable independently associated with chronic pain in univariate and multivariate analyses (OR = 4.8; p = 0.007). Intraperitoneal composite mesh placement after ventral hernia repair is safe with regard to intra-abdominal potential complications. Chronic pain is not uncommon, with chronic cough identified as the major independent predictor.